Nosebleed Diagnosis

The diagnosis of a nosebleed is generally self-evident and apparent upon seeing the patient, though some individuals may not have any active bleeding by the time they arrive to seek medical care. More importantly, however, your health care practitioner will need to locate the source of bleeding and determine whether the person has an anterior or posterior nosebleed. Furthermore, other less common causes of nosebleeds may need to be sought depending upon the individual's medical history and the findings on the physical exam.

To examine the nose, the health care practitioner will place medications into the nostrils (usually with a cotton ball) in order to numb the inside of the nose and constrict the blood vessels in that area. Numbing medications make the examination less painful. The medication that constricts the blood vessels shrinks the nasal tissue and may even control the bleeding to make it easier to see inside this small, dark cavity and identify the exact site of bleeding. A metallic instrument called a nasal speculum is then inserted into the nostrils to visualize the inside of the nose.

The diagnosis of a posterior nosebleed is usually made when attempts to control the bleeding with measures used for an anterior nosebleed have failed, or when an anterior source is not identified. Seeing the source of a posterior nosebleed is nearly impossible. Other findings suggestive of a posterior nosebleed include heavy bleeding from both nostrils or visualizing blood draining down the back of the throat.

Laboratory tests are usually not needed. For severe nosebleeds, however, a blood count may be checked to assess the degree of blood loss. For individuals with blood clotting disorders or for those taking blood thinners, additional blood tests may also be ordered. If there are concerns about malignancy or other less common causes of nosebleeds, further blood tests and/or imaging studies may be considered.